A RETROSPECTIVE STUDY OF THE USE OF CISPLATINUM-5-FLUOROURACIL NEOADJUVANT CHEMOTHERAPY IN CERVICAL-NODE-POSITIVE NASOPHARYNGEAL CARCINOMA (NPC)

A retrospective study on 422 nasopharyngeal carcinoma (NPC) patients w ith cervical nodal metastases treated between 1984 and 1987 was perfor med. 169 received neoadjuvant chemotherapy (CHEMO) with cisplatinum an d 5-fluorouracil for two or three courses prior to definitive radiothe rapy and 253 were treated by radical radiotherapy alone (NCHEMO). Whil e the primary tumour (T-stage) prognosticators had been comparable bet ween the two groups, CHEMO had significantly more advanced cervical no dal metastases with bulkier nodes and more low-cervical and supraclavi cular nodes (P< 0.05) which could account for its overall worse surviv al, poorer regional tumour control and a trend towards worse systemic tumour control. The worse regional control in CHEMO for Ho's N1 could be the result of more bulky nodes and more tumours infiltrating the sk ull base and/or causing cranial nerve(s) palsy. There was no statistic al or apparent difference between CHEMO and NCHEMO for the same Ho's o verall stages of NPC with comparable nodal and primary tumour characte ristics for the clinical endpoints of actuarial survival rate (ASR), d isease-free survival rate (DFS), free of local failure survival rate ( FLF), and free from distant metastases survival rate (FDM), despite th e presence of significantly more fixed nodes and bulky nodes. This sug gests a possible beneficial effect of the neoadjuvant chemotherapy. Ho wever, multivariate analysis has not shown the administration of the n eoadjuvant chemotherapy to be of prognostic significance. Even though the chemotherapy was well. tolerated with little toxicity, we recommen d against the routine use of neoadjuvant chemotherapy in cervical-node -positive NPC outside the context of a prospective randomised clinical trial.